Using Digital Integrated Community Case Management to Strengthen Protocol Adherence Over the Sick Child Recording Form for Under-Five Children Referrals From Community to Higher Level Facilities in Malawi: Affordance Perspective

Abstract

An effective referral system at the community level of healthcare for under-five children manages health needs by fostering relationships across all levels of healthcare, enabling patients to receive the best possible care and, in the process, saving lives. However, identifying those who need urgent referral mostly depends on community health workers (CHWs) commitment, which some studies have found inadequate due to nonadherence to the integrated Community Case Management (iCCM) Protocol, a protocol aimed at reducing child mortality and morbidity. Studies have shown that employing mobile Health (mHealth) may circumvent some of the limitations of paper-based iCCM protocol for patient referrals, which include assessment and treatment of under-five children. Despite the known benefits of mHealth in supporting CHWs, studies analyzing how the affordance of digital iCCM may strengthen protocol adherence over paper-based iCCM are lacking. Therefore, the purpose of this study is to analyze how the actualization of digital iCCM may strengthen protocol adherence over the SCRF, consequently, improving referrals from the community to the higher-level facilities for specialized treatment. The data captured from interviews, focus groups, informal chats, observation and document analysis were transcribed and analyzed using thematic analysis. We found that the Sick Child Recording Form faces challenges due to nonadherence to set guidelines, resulting in misclassification, incorrect drug prescriptions, and consequently, delays in referring patients with acute symptoms to health facilities for specialized treatment. As a contribution, this paper offers a new perspective on the technological affordances of digital iCCM that strengthen protocol adherence in patients' referrals from the community to the higher-level facilities that include assessment and treatment.